I agree to participate in this survey and to share my open and honest feedback to each question.

I understand that my responses may be utilized to inform future care models in Montana.

I understand that my responses are anonymous and that I won’t be identified by name.

I understand that by signing this consent, I am agreeing to participant compensation to be mailed to me at the address below in the amount of $50.

I understand that after my survey has been completed and my compensation has been mailed, my personal information will be separated from my survey responses.

I can choose to forgo the full survey at any time and understand that I’m still entitled to the full participant compensation.

I can ask questions or express concerns if I am not sure about or am uncomfortable with a question.

I understand that my name and address will not be shared, sold, or publicized.